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NPI Code Detail

MEDICARE: LARISSA MOON APRN

MEDICARE: LARISSA MOON APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0200XPediatric Nurse PractitionerAPRN11014384FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1437810280
Entity Type Code : Individual
Provider Name (Legal Business Name) : LARISSA MOON APRN
Provider Business Mailing Address
First Line : 10140 CENTURION PKWY N
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32256-0532
Country : US
Telephone Number : 904-697-4100
Fax Number : 904-697-5102
Provider Business Practice Location Address
First Line : 651 N ALAFAYA TRL
Second Line :
City : ORLANDO
State : FL
Zip : 32828-7045
Country : US
Telephone Number : 407-273-4132
Fax Number : 407-332-5157
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/04/2022
Last Update Date : 01/04/2022

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